54 year old male chest pain
54 year old male patient sitting at home when he began having a sharp substernal chest pain radiating to his jaw. He is fully alert and slightly anxious also c/o shortness of breath and nausea. Skin is pale diaphoretic, lungs sounds are clear and equal. Pain is 8/10 and nothing seems to make his pain better or worse. His history is CABG and Defibrillator.
BP 110/50
RR 18
Pulse 60
No other info available
12 lead (sorry for the quality)
Local ER is 20 minutes from scene. The closest PCI center is 1 hour and 20 minutes from scene.
How would you like to proceed?
Here is the conclusion
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Inferoposterior STEMI. RCA proxymal oclusion
Infeiroposterior STEMI, RCA and LCX occ
badness
He has an inferior MI – elevation in inferior leads with reciprocal changes in aVL.
Id take a posterior ECG aswell, to confirm or refute the posterior MI (I;d expect it to show elevation).
And a V4R too, to look at the right ventricle. Under my trust guidelines if there’s a RVMI and hypotension we can give fluids, so do this incase BP drops en route.
Need to go to PCI. Morphine, Aspirin, GTN (carefully cos of BP)